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HomeMy WebLinkAboutbocc.con.012.1994 h • �i 4�"ry L � ' ifr.� <+�.' . �7 � ,1 -�j � � .�� ,'i t : :: ����F� I�rt��i,: ��-'� r ' . S, �rys/ � �.�.:�i irtnb �����5 ��{�,b,�.ti��. .�� . . "� , K f Wi ��lA�l"'IN� .RIY��� �� .�,'"'�r#,Y'�.F, ..�,y, �.. . �'��.�.Nls..:3�.'� ,A:i.' / :., y.JFf�f , .r`�/�vfi'��� �.�,.;:.e, r�tt' ��,tc$;?Lx.,. � k7` j , r ... .- �� � � � ' � � . � . ,' . . . � � , � . . � - � ?+ ���y`�2 .. ,= � , , GRANT OF LICENSE/PERMIT ,� The undersigned, representinq the Board of County Commissioners of Pitkin County, Colorado, docs hereby grant a license to the _G" � above named applicant to provide ambulance service within Pitki.n . _ � County. This license shall have upon it any restrictions listed �C•. below, sha1J. be granted any waivers 2isted below, and shaZl be valid for the dates listed below, unless revoked by the Soard pursuant to the provisions of Resolution No,. 87-� RESTRICTIONS: License to cover those operations connect d wtrh e-i area service. m WAIVERS GRANTED: Scoop Stretcher Mast Pants . �' . . � � � . . j. - � THIS LICENSE IS VALTD FROM/UNTIL: January I, 1994 unt31 llecemU r �1 1994. � : �, c �-f �' � /7�. �k, �f DATE: �' �r,�G'1�c-�l�l/ �I 1'' � CHAIRMAN, BOARD OF COUNTY COMMI55IONERS � ,� ;j r n� ;}:" -�ak'�p.4� r�..+�.r:�.:.� ...;,,-.:.,.�.�„ � . � . .t,...�.�.°.,L�. ::;�+ �-�-� - : .. . •�'l�.:ti ..e,� ,+�.5..;,,�„tX�tes�Gi,�'^;'«.�'�} `� � � ��� � -� ,. .. � ._ : - -� R ; _.;; ��• . \� . 1 . . �'.r . . . . . � � . � . . � . � . � � . .- � .. . � . � �� . 1.�. � . ��. . . � - , .. . . . � . �h»'�T� . . . ��3. .. ��.. � ����F r�(RA���I�f.�-r�, .'� �. `A�� r l� / �::� ��r �'� 7 : ,_ .. U fY s 1t�� 't�x �� .. . � " � -,� F 3{�',+y.,. � �i t .` �'�'��;.�•- -c ew�`$. . : �� .�7�a.�;��Jl.�'Y'��!. ,"�.� . �+ • � � - f ..: ' � � ����. . ,.� - �� . �:�: � �� .,b;�- L � �x��� � ..0� rs-+ �. ; ��'-. � . 'r � � .....__..n_..,_...�_._ .._.�_�. . � � r�-.. �.- _ .,>.;�` ,;��'�.'s: � �� � � � i �� � � � �.,�, . � - ;:, ; PITKIN COUNTY APPLICATION FOR AMBULANCE LTC�NSE . { � PLEAS� TYPE ALL INFORMATIQN - SERVICE NAME: hS S�e-n S�� Co 'A w�I�u.I zi.�'1C'2 �'� ADDRESS: -l��.� � Cr, ;slG�I OWN�RS OR OFFICERS:�,p�vi 5�i Cv • � • C'n r 1 ScYn � 'r�. PHONE NUMBERS_ �'/�.L 7 /L ZO ' DESCRIPTION OF AMBULANCE: MAKE, MODEL, X�AR, LICENSE NO. ` j l �'lk�7 5 ,eorlvRVl ✓G5 - �'/ 7�' ADDRESS AND DESCRIPTION OE HASE OF OPERATIONS: SQ'vr7��/4�7{.,Aa'I�S S�-� �w�" �, � �j. � PHYSICIAN ADVISOR: ���C+I/SSrn 4[!J —.r. COLORADO CERTIFICATION NUMBER: PHONE NUMBERS: 5�.'� 1 Z Z.c7 SIGNATURE• ./��(iC.�� �� cs WAIVER REQUESTS: SCUc�h � c ; . � � . �. . - . ��5� � . � . . , � . .�� . . . . . . . . . ��,4.. �,� APPLICANT:����JrLS �� �r . DATE: . �e�-'fS� I� � ��' �; SIGNATURE• � i' �� � '�: � � �i . � ; � . �, r .a�.�P��'.�,. �� ,� F:. . ,rt�ti.x..��= ,.,�.: �.k ..ta .�,....,w„� ..�,�._� ...�.�:u� . -�"";�?�,�',a,�^'3::. s 4 \ . - . ' . _ , � . f ��� ..�",� . : .� � �M1 �b��a, � ���i�.'�- fa ;"- ��a`� �� -;r t .� a� y���`S�i.,... �� ��t: �'u§ i ��d �'�._ .:_t ...: .... dx r . ,� .. V ry ' r . .� t x " - .,� .�.. �.!��irk- �Y ; 'Y..3 p.''sT� ,y,tr,�_.. .. ... �� I . .. ��.�.:}eL'I�..Jl���'{ ���i.� 4 ��L T)� � _ .,._ +''.D:.' y :.a�Fti�T, 2 .' '�"_'_....��.__�.�_"' _..___.. + ` • _. } • : ... .. . . � �,}'�41�.:; �.. . - , : • �g�Uy}. � �.. ��:>� PITKIN COU�tTY At1RU1_AIJCF TNSP[CTION LIST � � �: ' Service Namec--,_!5 51� G V✓���L`CGi-SL� � : --�-�.____-�_-�----�------ _ , , :�--- ----------� .- �;..�. �s ---�--��-----��-J-��Y.4�<> ,M e c;� �c� ,�.. Vehicle Desi na tion• S �-t^� � � �-� 4 . l.icense Plate___V�!S �I`7� _ � ''s---------- -- ----- NCIC_--CCZC___ , Inspected 9Y=----y-�-�.___`L�J_�1���. DaLB_ �j__�. _��J� !„ •�. InspecCor's Signature, if passed=_ _ ________��=C,t=�� -`�/_�--- ITEM YF_S NO Current Vehicle Registration X P�-ooF of Insurance � __ _ � All vehicle lights working " - . �,L�- - �. -:' All emerge�cY li9hts worl<ing `]�' ,/�.%f,'. - .. ... . ..�f-3' _��� . . Secure storage af equipment � �---- ---- i�ortable suction apparatus with wide-bore ' tubing and pharyngeal suction tip �_ ___ Bag-valve-maslc with adult, chi.ld, and infant .masks_ Must have reservoir capabil9.ty �_ __ � Oropharyngeal airways_ adult, child, inFant sizes ,�_ ___ Nasopharyngeal airways_ adu1L-, child, infant x_ ___ � � - t '. .. Portable oxygen syst'em includingc tanl: & regulaLor ____ ,___ ; adult, child, infanL- valveless maslts _�_ _ i k.. ���' ; � 2 ��asal cannulas _�_ ___ I;�,; �, ,' � Two clean burn sheets _�?� ____ �� � Triangular bandages wiL-h safety pins ,�,( ____ S� 1? . . . . . . . ��( . . . .,j� . . . � � . . . . ' .. _� � . . . . . � � � , . � g� :'�aa�.ti-..F.�.�r.� -..s.-�.-........ - '— � . � . . . . �1 ... ', '_,_....__ .�..�......�....�..:-....�.,..,.�,.,..�y_....+�,ev;.W�.v�^x,z:..,.._..,+��...,..-,,.t..�:-:.:w�_..w..,...:.o..� -'�s e3�': , ;: ��. . .. . ��:i y .,�'��r } } b ` t ; > � �- � � `:., � -- �:.' . .l _ � �6 � . . . '� �. . .. . � � � 1.��,- :.� �# `��� . .. . . . . _ . . � � .. � . . . � . � . � � .. jR� n� � �y�Cd.,��.�t 11 _ "•F�. , ',r "�f i .���� � r".; rf�_�: � 1 �..�. .. l��in � lA����� 1j �.v �<� ,''f f i `.�5 ,1�'��� L+J'7.i t SY ����+ . Jl,, .d�"i2 . .. �A lf��.�grv. �t1�.n� Y, fYt . � � . h'f� i� � �'" ..:•I.�wk1 iT:Y3 "us ."� + r �t�y��� � �� '1 3�11,�. # .. t. , Y �_,_ F u �L��)�j ��! (� J� ��yy�y, C¢�j�y T �: .��6. f I,•!�:� . A. . �J.. "'l�'t�R� .y `� � (_'l.fF1'lr _. . . .:... . ' . _. . �- '`�{`vq.:. : �� R � • . '� � . . . . .. � � � . • � . /� J ' _ '__.` -'� 4 soPC roll.er bandages, A inch ___- : I - Two ace bandages, 4 inch _�- ---- I Two each 2 inch and 1 inch adhesive lape ..,�_ ____ 4 vaselihe ga��ze pads .�-- ---- Two tubes of glucose �-- ---- k. Twa 30cc bottles Syrup of Ipecac _�_ _ One 50cc boi:tle of charcoal x_ ---- One pair of M_A_S_T_(Pneumatic anLi-shod< garmehL) _!`�.b ____ "_.:- .:i•: . � Requested Waivers of County 1"equired equip�nen�, �Proin applica�ion_ . � �� - ------------------------------ --------------------------------- . �..� ,`; � � � ) . �. � .-. .�. � ��IIsL��__�?�_���---`4--�x-°�l---�-�`-�-`c.,L\4-�_--- . _U -, .. .; CO -��--��=------------ ------------------------------------ --- - � ::. ------------- -------------- ----------------------------------- : : �� �- �--- �..- _�.. �---------------------------------------------------------------- -� . � .4 . - . . . . . . �: '� C J'.:. . . _—__—___.______�.. . :' � ���� ...- � ..'' . � ____________________��_________�_____`__�__ . . . ����_____�������_�____ . . . :---.::i - . . . . . �.. . . � .��....,�-.� . . � � ' �;.�..� . . . � . . . .. . . .. . .. � . . ' � �.:� � ��_���____���_____�����_� . , . �����_______��___�__���__��___�__���__� . �� ...' __��_ t� . . ��_���__�__�_���__�__�� . . .�_��__�___���__��___�___���______ . . - . . .� . . . . . . � � � .. . . " . . . f . ' . . _��_____��_�__�����— ' ____�______��__���__—_________�_�_--______��� . I . � . � . . - . � . �.� . .� � __��_��__�_����__��.___�___�______________�—__�—___��_��___����.�� . � .. . . . . . � . , " . I`'. . . . � . . . � . .. _ .. � .. i:l '.. .,. �' . .. . . .. . . .. . � . .. .. . .. . :. ... �. . ��•� � / . � ' . . . .. . . � . . .. . ' . . �� . . . ' . . . . . . . . I h . , �J,aS�.,S��Y3�P.r s. __ � ,+.�.------•-'•�^C�cW1; � �htr Y.. . .. • -��. rW. .:. .. .. . . . ., � . �.�. .. . . ' "S�{. . ;�� '' : ' .�. �•.��, ..-�.. '., .,.. �� :. . . , . . . . . � . �.� '', � . ,p'`���: . � � . . . � . . �. . ; � - . , � Q � �. .. . . � . . . � . . � . ' �-�Yi.Y. � � " � . � � . . . �_ � � .j'::�.�� .� ..i4' 3 ... � - (� �} � �} _ � - SCY L ],�L ..� A-.� �� �.: i, y�.tP ��'i,, ' ���rb � iu� i� t f� � ` ' .. ,.. w�. f � i ' iF. ` , �. �rr .. .� � i• ,s � 4! 1�7 C °y�8 .,��u�, �aA, a d�,:,�'� ,�.sb'�'� �- ��'�� . ytt. ti�j.,�, k � k t' . �1: s� _ . �V '�'��' .y�'s 1 > � �.�K'�•''` ��.�`}�'S� `: � � . . . � .- . .. .. �::iM<Bt. ,. .^�' . . ...j . Ti�!� `��''�7Y,��.' . � . ..... . .. . . . . . ,� �,-': . Y'�1 � � , � ��' . . �.'l�" .. . . . � ✓ "y (... � v.J : _t,'� � � s � f_ower extremity tractioh splint �,_ ' + : � Extremity inunobilizing device X__ ____ � ' � Lon9 sPine board ---- �r. �-- X. C.... Shori: spzne board or equivalen t .,x_ ____ i • . { y Sterile obstetrical kit ,�_ ____ ' Two-way hospital radio system �__ ____ s ' One adu.lL- B/P cufF X ___ �: , One child [3/P c�afF �_ _ ' : Two stethoscopes �_ ' SLerile irrigation svlutian /�._ ____ 7-- Roll oF aiumirtum Foil or space bl.an!<et �_ _ Shears or heavy scissors �_ _ _ " � �� 7wo Flashlights �. _ _ i - f��.:.% . . � . `i One lOit or two Sit fire extinguishers ,�__ ____ , One pocket mask , _,�_ �.- Vehicle oxygen system capable of delivering , -- ---;�; ; 10 liters for 90 minut•es = 900 liters �__ ` One Scoop streL-cher l�(,J ' ' One each, large, medium, small, C-coliar !�_ __ � . � ' -- f One alternate svstem for cervical immobilization' ;; j . such as= sand.bags, IV bags, foam pads �_ ____ r Twa b5.te sticks -�- -_-- � , � � Emeszs basinCs) with one quart capacity . . . . ,x_ ____ � �°; `� Three blanf<eL•s �' �- ---- - Four each large and small universal dressings �,_ ____ i 9 � 24 gauze pads (4x4) -�� ---- � �. �. �ne uhiversal urinal .�_ ____ Z.�' . , ��::� �� , .,�..� . . � . . . . .. . � � . .- � . . � � J 4 . rT�3�',fY�'�`'�'�a,.�I6L14°�'iuiva* _'*" '_ �«..-...z:a. -..:s:4-c.....� .-..w;';;7a`.a{�a�-u�.;t.,�a-.-�t..w.v.�b:�'y.�x;oraai:'�.,.'S. 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C . -::j � ��M• Phons .,�^ ^� �_�( � .�°�/3 - Fux ol�J . � �_ �^ Fn[ � . .. •„' . � 'J-� �! �� . , t�JG�U��•�� _ �i�� ' �..,.. , �..... ,t:_. ; � ;y ; ���''��'ri�"`'���Y�'�' .�.s�.'i�c. � � coLOxnno INSUHANCE IDEN'fIFICATtON CAND � 4ti'; '.�*i . �yrwre� � . .. CpMP�NYNlM�9ER CO�IYANY . � . - � � flartEord Sncurance C.roup - � � � � � - , pOUCVN�IMBEN EFFECRVEPAtE E7tPWATqN0�7E � � ' 74'UEN E50419 10'O1 93 LO O1 94 � `',z+#�. . . ' TEAfl MAKElMOOEL � VfiNIClflIOEMT¢'IGTqNNUMUER � � �. ALL OWNED HOTOR VElIICLES '��� �.�� . . �oHwc+�MOMP•w�ssu.+oc+nc � . . Lock[on Silversmith, Inc � 341281 . . . awneo . .. � � � I I—Aapen Skiing Company � See IH1200 r P� Box 1248 I Aspen Co 91612 � � � . L .. . . � . SEE IMPOATANT NOTICE ON REVERSE SIDE �j ceeINOLLWOdU070HO�vo (19JU0S�N0'JV YS'11WDwuvd (cel['03) L•iLU�17�J J .7 . � -peMOnui e�o�yea yoee�o{teqwrta+C��od pue�(uedwn�s�uemsu��o ewaN 'Z _ "x�� •sseip�M pue�a6ueeeed'�enyp yoae)o ese�ppe pue awaN •► ,?.� :uo�iaiwolu�Ouunoltol e41�!BlQO , ' fE00•6Z0•00@-1 , �. � � � � .. . :s�iaqwnu eeia-poi ana4 9Z a�P�IYBH BU.L'e1Q!8¢od 98 u0os. . . � . - . . . � �. .. � � � � • ss lue6y�no�(�o p�oyUeH 6410�elucp��e po Yodey:iN3Q�00Y d0 38d0 NI � � .. -. � � QNVYV3tl NOdf1431N3S3l�d ONV 3"1�IH3n 03H(1SNI 3H1 NI 1d3H 381Sf1W QkiV�SIHI k'� �' �} . - ;- � . � � � � . . :'GY.?. ta�'a'p':1?:..`.�:�rko'w,:r�il'.�. �'�!P,;�: �,�.`'�:�+1!r�•;�?'fiJ"� . �. . . . ' . . . � . � � � � . �. . � � . . . . � � � . �'. / � �� � . . . , .. � . .. . . . . . � . _ . .. . `�. G . .if .. �� ' . . � . � . . . . . � .. �. . � _4� . . . . . .. . �-� . .. � . . . .. . . . . 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'�.` ri ?�-T{�--� ; . r . `�a*�� `'.��. , � ..�.<... <- _ • ' , + SENT BY�ASPF�V SKIING C0. ;12-16-93 � 11�15 . 3U351UU771� �u�azua;�uic� i> i" '�- _,. � ' . , . . K� � � � L,� s _ i � �« . . . . . r,-. � � � . . � � . . -. . � � . - S : d . ` :�_'' � 7 '. , � � � INSURANCE IOENTiFICADON CAHD I ���CO � �.,. muFrH+r�xNaw HARTFYORD INSURANCE GROUP ,��.' ( UEN�SU�9 e�rxernco� e�o.h �f 10/O1/93 10/01/94 � 1rE�4�%EOENnfl[a710NNUMBER E. 1987 ChevY �V� . 26AFG3SK7H4118264 � „�,,�.�u,,�,,,��„��a, LOCKTON COMGANIES � 4500 Cherry CYeek Drive South 303 753 2000 Suite 400 �;'" , Denver, CO 80222-0099 �� . � nmxmo - . ... . . . �A�pen Skiing Company - ` P.O. 8ox 1248 Aspen, CO 81612 " L . %� 1 ' 001768 y � � . . . . �L't 4�1"c]IT041f Nl��[:�pN FEVEIISF SIC{ � � ,5 � j: .. . � . . . . .. . � . .. . - . . .. ' k . z /lGf�L.I�I�� �d`GBC�CLf-�i�l« , �' � . ,.• ' i Poat-It°brand lex transmittal memo 767i a ot v+a•� -+ � � � . � �� 7b . F .� � . . ' . �- . � � - � � � Co. � � � �I � . . . � '��: Depl. Phane D_ C . . F. `1 . . J . . tit .: _ .. Faa/ _ u/ � . � . � . .!. � . . . . ��-S. y-` �.� . . . � � • i.�'.. . . � . . � � 1��. � .-� . . . � . . . .. . . . . . , _, . . . . .. . ' i' � . � .-. 4'� I V ���fy� ,�y , �'� y . ' �t�r+', i �-� � .___ _ ..__ 1Y J ti �� , ;;x�9�+��^-.r",��-�---.�_—--_"._,. --- ��,..:15,'. „t.2i;.;u.`: M.,...w:��a�+�afi:.v:l;r.w.r.k.m..';,:ns,ti,?.'..�' 3 :'a�+:;?—`"' f:. . :j�a� ,1' . ; �' 1 iI � . ''.... . ,�... . l .. . . �:. . .�: ..: . . .. � . : . . . .. .. . .. . �. . � .� . .,� �. �: ' . .. . �. .. " � - � .. ��°".;�� " . . - , . . - ' . . . . �.. � .. . ��� .� r�